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Osteoporotic fractures, particularly of the hip and spine, are associated with premature mortality. To evaluate the extent of this risk, researchers followed 4005 older community-dwelling Australians (age, ≥60 at enrollment in 1989). During the next 18 years, 1295 participants (952 women, 343 men) experienced fractures of any type, most commonly involving the hip, vertebrae, pelvis, femur, or multiple ribs.
The mortality rate for participants with fractures was roughly double that of participants without fractures; relative mortality rose further after subsequent fractures (doubled for women, tripled for men). Elevated mortality risk continued for 5 years after fractures, persisting for 5 to 10 years in patients with hip fractures. In a detailed study of a subset of patients with fractures, the main clinical factors associated with excess mortality were older age, subsequent fracture, weak quadriceps strength, smoking (in women), and low physical activity (in men). No association was noted for chronic disease comorbidity.
Bliuc D et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 2009 Feb 4; 301:513.
Comment
These results demonstrate that, not only is osteoporotic fracture associated with excess mortality, but that this risk persists for several years after any fracture and as long as 10 years after hip fracture. In addition, excess risk occurs regardless of the location or severity of fracture and seems to be present regardless of chronic disease burden.